Sen. Cassidy Maps a Plan to Overhaul Obamacare

Sen. Bill Cassidy (R., La.), a freshman senator and a physician, wants to help shape the Republican’s health care policy.

Andrew Harrer/Bloomberg News

Sen. Bill Cassidy of Louisiana is throwing his hat into the ring of Republicans vying to shape the party’s health care policy this summer.

GOP lawmakers have been wrestling for months over what to do if the Supreme Court strikes down the Affordable Care Act’s tax credits in most of the country, a move that would upend a big part of the law. A decision is expected in June, and Republican leaders believe it will give them a chance to overhaul a law they have long opposed.

Mr. Cassidy, a freshman senator and a physician before going into politics, outlined a plan to let states choose to opt out of the law, widely known as Obamacare, if the court strikes down the credits.

“We give patients the power by lowering costs, repealing the mandates, and returning power to the states,” he said in interview. “We do away with Obamacare mandates,” said Mr. Cassidy of his plan. “I accept the draft and income tax but for them to tell me I have to buy insurance… someone is telling me what to do.”

Under the Cassidy plan, states could take the money they would have received under the law and give it to their residents to pay for health insurance in other ways. Also, in participating states, people wouldn’t have to pay a penalty for going without health insurance, and employers wouldn’t be fined for not offering benefits.

Residents would get health savings accounts with age-linked contributions — but they wouldn’t be means-tested, so lower-income people would pay the same for premiums as wealthier consumers. They could use those accounts to pay premiums for buying insurance on their own, as well as paying out-of-pocket costs. States might also be able to take steps to automatically enroll all residents in basic, catastrophic health coverage.

Insurers would have to sell coverage to everyone initially but could later limit coverage for people based on their medical history if they hadn’t bought insurance during the sign-up window. States would choose whether to keep other tougher requirements imposed by the health law for what benefits must be covered and how much insurers can charge older people.

Mr. Cassidy envisions his plan taking effect within 18 months of a Supreme Court ruling. He says it’s designed to build on proposals from fellow freshman Sen. Ben Sasse of Nebraska, and others that would allow the law’s tax credits to continue flowing for a “transitional” period of time to avert disruption. “They are not competing, they are complimentary,” he said.

The senator is banking on a Capitol Hill “meritocracy” where “it doesn’t matter that Cassidy is a freshman” and hopes his proposal will either win out, or at least influence the final product. He says he’s not afraid of a messy debate, though some conservatives have said that Republicans should not take any steps that would entrench aspects of the health law, such as its big price-tag or sweeping goals to extend insurance.

“What we’re doing is converting it. I think the long-term dynamics of this are better,” he said. “Under this ruling you get the worst of all if you do nothing… This is a much more likely scenario to uproot Obamacare than to say, ‘Let’s not do anything.’”